Khuyến nghị về Thông khí Cơ học trong Gây mê toàn thân cho Phẫu thuật Chấn thương

Current Anesthesiology Reports - Tập 12 - Trang 183-191 - 2022
Kevin P. Blaine1
1Department of Anesthesiology and Perioperative Medicine, Oregon Health & Science University, Portland, USA

Tóm tắt

Thông khí cơ học là một phần thiết yếu trong phẫu thuật gây mê cho chấn thương, nhưng có rất ít khuyến nghị về quản lý máy thở trong quá trình phẫu thuật. Bài tổng quan này xem xét bằng chứng hạn chế về các thực hành máy thở trong phẫu thuật chấn thương. Hầu hết các khuyến nghị về quản lý máy thở phẫu thuật được lấy từ các hướng dẫn của ICU, nhưng phẫu thuật chấn thương bao gồm những yếu tố không phải lúc nào cũng có mặt trong ICU. Trong phẫu thuật chấn thương, cần duy trì normoxia hoặc thiếu oxy nhẹ. Tăng carbon dioxide cho phép có thể có lợi trong trường hợp không có kiềm chuyển hóa, nhưng ưu tiên nên được đặt vào việc duy trì pH > 7.25. Thể tích khí lưu thông từ 4-8 mL/kg·IBW là khả thi nhưng khó khăn khi độ tuổi, chiều cao và cân nặng không thể được đo chính xác. Chiến lược giới hạn áp suất có một số lợi ích tiềm năng và nên được xem xét. Thông khí cơ học gần như hiện diện khắp nơi trong phẫu thuật chấn thương, nhưng chỉ có nghiên cứu hạn chế về các cài đặt máy thở tối ưu. Bằng chứng hỗ trợ việc giới hạn thể tích khí lưu thông và áp suất lái trong quá trình phẫu thuật.

Từ khóa

#Thông khí cơ học #Gây mê toàn thân #Phẫu thuật chấn thương #Quản lý máy thở #Hướng dẫn ICU

Tài liệu tham khảo

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